| NPI | 1265989560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U2044) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA MD-45799) |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2024-11-27 |